Mental Stimulation, Neural Plasticity, and Aging

Abstract and Introduction

Abstract

An unprecedented increase in the number of older adults and consequent age-related cognitive declines may negatively contribute to an already overwhelmed healthcare system. Many older adults report cognitive changes and express interest in methods to maintain cognitive functioning. Mental stimulation that consists of cognitively challenging activities is a means to facilitate neural plasticity, which can increase cognitive reserve and result in maintained or improved cognitive functioning. In addition, compensatory activities may provide mental stimulation that can improve cognitive functioning and increase cognitive reserve. Several mental stimulation (e.g., education, cognitive remediation therapy) and mental compensation (e.g., spaced retrieval method, method of loci) strategies are described in this article. Because nurses have a significant amount of direct contact with older adults, these strategies have important implications for nursing practice and research.

Introduction

In 2006, there were approximately 500 million people age 65 and older worldwide. This number is expected to increase to 1 billion within 25 years (National Institute on Aging, 2007). In the United States alone, the number of individuals over 65 years of age is expected to double within the next 25 years to approximately 72 million, or 1 out of every 5 people (National Institute on Aging, 2006). Although increased longevity is in many ways to be celebrated, the exponential growth of the older population creates many challenges on an individual and global basis.

Primary areas of focus regarding older adults include independence, functionality, and quality of life. Each of these areas is compromised by cognitive impairment, which is particularly prevalent among the fastest-growing segment of the population: the "oldest old," those over the age of 85 (National Institute on Aging, 2006, 2007). Cognitive impairment can occur without dementia; both are on a continuum of mental functioning. Cognitive impairment is a loss of mental abilities that interferes with normal thinking, while dementia is a progressive loss of cognitive abilities resulting in a total loss of autonomy and ability to function. Between 11% and 27% of older adults exhibit some level of cognitive impairment without dementia (Busse, Bischkopf, Riedel-Heller, & Angermeyer, 2003; DiCarlo et al., 2000; Graham et al., 1997; Hanninen et al., 1996; Schroder et al., 1998). Likewise, Cigolle, Langa, Kabeto, Tian, and Blaum (2007) found nearly 32% of individuals older than age 90 reported cognitive impairment. These estimates of cognitive impairment exclude adults who meet the criteria for a dementia diagnosis; consequently, the percentage of older adults with a cognitive condition is much higher. The oldest-old population is at a much higher risk for cognitive impairment and dementia and the resulting complications and disabilities. For that reason, finding ways to improve or compensate for cognitive impairment remains a challenge for research and practice.

The term mental stimulation often is used to refer to any activity that requires cognitive processing. This article defines mental stimulation as the explicit use of activities that stimulate the connections between neurons (i.e., neural plasticity) to augment cognitive functioning. The use of mental stimulation to facilitate neural plasticity is vital to maximize cognitive functioning in older adults. Principles of mental stimulation and neural plasticity will be presented through evidence-based studies that demonstrate their effectiveness in improving cognitive reserve and functioning. Methods to mentally stimulate the brain to increase, maintain, or compensate for such damage are posited. Such methods are highlighted in a flowchart for ease of interpretation and quick referencing. Implications for nursing practice are identified to help nurses provide mental stimulation to older adults who wish to improve or maintain their cognitive functioning. We conclude by providing suggestions for nursing research to further incorporate these psychological concepts into nursing practice.

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